Images in Transplantation (CME)

A Surprising Renal Graft Doppler Ultrasound in a Kidney–Heart Transplant Recipient: When Hemodynamic Analysis Is Even More Informative Than Usual

Doppler ultrasound of the renal graft on postoperative day 21. Color and pulsed wave Doppler of an interlobar artery during inspiration (red dots) and expiration (green dots). Cross 1 measures the arterial systolic peak velocity, and cross 2 measures the end diastolic velocity. Resistive indices are normal on expiration at 0.70, and severely increased on inspiration at 1 (due to the disappearance of the antegrade diastolic flow). These variations were not secondary to patient's motion.

(A) Anterior–posterior chest X-ray on presentation demonstrated a large 13 cm cavity in the right hemithorax likely representing a large lung abscess. An empyema is also in the differential, but would be considered less likely. (B) Coronal image from a CT performed on admission demonstrating a large focus of infection involving the right lower lobe with extension into the right pleural space and chest wall via a bronchopleural fi stula.

Current Issue Highlights

HIV and organ transplantation each emerged as significant disruptive forces in healthcare in the 1980s. Our rudimentary understanding of both led us to draw boundaries around their management that have, with time, been erased, as their perceived mutual exclusivity has given way to an appreciation that transplantation can be an important therapeutic modality in many HIV-related comorbidities. This month, we highlight articles relevant to the HIV Organ Policy Equity (HOPE) act, new legislation permitting HIV+ donors to donate organs to HIV+ recipients. “The AJT Report” covers practitioner perspectives of this new law, and Boyarsky et al review clinical decision issues relevant to HIV+ to HIV+ transplantation. Articles by Locke et al and Richterman et al report new data on the management of HIV+ recipients and the prevalence of HIV+ donors, respectively. Also, be sure to check out the new AST/AJT online journal club taking place Monday, August 31, at 4:00 pm ET. Participation is free to all; register at myAST.org/journalclub. Cover design by Ken North, North Design Group.

The AJT Report

After more than 20 years of discarding HIV-positive organs, physicians in the United States now have an opportunity to provide transplantation to hundreds of HIV-positive individuals each year. We look at how the transplantation community now approaches HIV and what challenges remain. Also in this issue, new research finds common ground between transplant immunosuppression and HIV immunology.